Restoration of Corneal Sensation With Regional Nerve Transfers and Nerve Grafts

Elbaz, Uri; Bains, Robert; Zuker, Ronald M.; Borschel, Gregory H.; Ali, Asim

doi:10.1001/jamaophthalmol.2014.2316

Cited by 117 publications

(146 citation statements)

References 24 publications

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“…When corneal transplantation is required in the setting of severe neurotrophic keratitis, the prognosis can be poor (Elbaz et al, 2014). In addition, available antiviral treatments for HSV keratitis do not stimulate the recovery of corneal sensation.…”

Section: Discussionmentioning

confidence: 99%

PEDF plus DHA modulate inflammation and stimulate nerve regeneration after HSV-1 infection

Neumann

Kakazu

et al. 2017

Experimental Eye Research

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Herpes simplex virus type-1 (HSV-1) infection leads to impaired corneal sensation and, in severe cases, to corneal ulceration, melting and perforation. Here, we explore the potential therapeutic action of pigment epithelial-derived factor (PEDF) plus docosahexaenoic acid (DHA) on corneal inflammation and nerve regeneration following HSV-1 infection. Rabbits inoculated with 100,000 PFU/eye of HSV-1 strain 17Syn+ were treated with PEDF+DHA or vehicle. PEDF+DHA treatment resulted in a biphasic immune response with stronger infiltration of CD4+T cells, neutrophils and macrophages at 7-days post-treatment (p.t.) that was significantly decreased by 14 days, compared to the vehicle-treated group. Screening of 14 immune-related genes by q-PCR showed that treatment induced higher expression of IFN-γ and CCL20 and inhibition of IL-18 by 7 days in the cornea. PEDF+DHA-treated animals developed less dendritic corneal lesions, opacity and neovascularization. Corneal nerve density increased at 12-weeks p.t. with functional recovery of corneal sensation. Treatment with PEDF+DHA that was postponed by 3 weeks also showed increased nerve density when compared to vehicle. Our data demonstrate that PEDF+DHA promotes resolution of the inflammatory response to the virus and, most importantly, induces regeneration of damaged corneal nerves vital for maintaining ocular surface homeostasis.

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Section: Discussionmentioning

confidence: 99%

PEDF plus DHA modulate inflammation and stimulate nerve regeneration after HSV-1 infection

Neumann

Kakazu

et al. 2017

Experimental Eye Research

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“…The technique and principles of this strategy were developed in Toronto and reported by Elbaz et al 49 and Bains et al 50 to use a reversed sural nerve graft, coapted to the supratrochlear or supraorbital nerve and nerve fascicles sutured subconjunctivally to the perilimbal region. A transverse sub-brow incision was used to access the supratrochlear nerve, and end-to-side coaptation of the sural nerve graft was achieved by creating an epineural window.…”

Section: Introductionmentioning

confidence: 99%

“…Interpositional nerve graft techniques coapted to a healthy donor nerve: A–F, Elbaz et al ,49 Bains et al ,50 Weis et al ,59 Fung et al 89; and direct nerve transfer (G, Terzis et al ,48 Allevi et al ,53 Ting et al ,57 Leyngold et al— supraorbital nerve only56; H, Jacinto et al 54; I, Professor Gennaro (personal communication, 2017).…”

Section: Introductionmentioning

confidence: 99%

“…In 2014, Elbaz et al 49 and Bains et al 50 reported outcomes using a reversed sural nerve graft, coapted to the supratrochlear or supraorbital nerve and nerve fascicles sutured subconjunctivally to the perilimbal region. They harvested the sural nerve proximally to distally using a nerve harvesting device placed around the nerve and passed distally, freeing the nerve from surrounding tissues 63.…”

Section: Introductionmentioning

confidence: 99%

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Update on corneal neurotisation

et al. 2018

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Corneal neurotisation describes surgical restoration of nerve growth into the cornea to restore corneal sensation and trophic function. It represents an exciting and effective emerging treatment for neurotrophic keratopathy. Techniques described to date involve either direct nerve transfer or an interpositional nerve graft coapted to a healthy donor nerve. We review the experience to date with particular emphasis on a detailed review of techniques, outcomes and current thoughts.

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“…Surgical neurotization is a revolutionary treatment that directly addresses the etiology of NK to offer a potential cure. When successful, it facilitates corneal healing and prevention of corneal breakdown, while preserving vision and decreasing reliance on medications [5][6][7]. Additionally, it can transform patients with severe, irreversible corneal scarring into better corneal transplant candidates.…”

Section: Introductionmentioning

confidence: 99%

Anatomic characteristics of supraorbital and supratrochlear nerves relevant to their use in corneal neurotization

Domeshek

Hunter

Santosa

et al. 2018

Eye

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Background Corneal denervation can lead to opacification and blindness. A new treatment technique, surgical corneal neurotization, transfers healthy donor nerve, (most commonly contralateral supratrochlear or supraorbital) to the affected limbus to prevent corneal destruction and improve healing potential of the cornea following insult. We examine gross and histomorphometric anatomy of the supratrochlear and supraorbital nerves relevant to their use in corneal neurotization. Methods For each of nine adult cadaver heads, bilateral supraorbital and supratrochlear nerves were dissected from the supraorbital rim to the anterior hairline. The following data were recorded for each nerve: exit from the orbit through a notch versus foramen; horizontal distance from midline at the supraorbital rim; and distance from orbital exit to first branching point. Samples of all left supraorbital and supratrochlear nerves were obtained at the level of the supraorbital rim and at points 3 cm and 6 cm distally for histomorphometric analysis. Myelinated axon counts were determined for each sample. Results Four supraorbital foramina, 14 supraorbital notches, two supratrochlear foramina, and 15 supratrochlear notches were identified. Average supraorbital and supratrochlear distances to midline were 26.5 mm and 21 mm respectively. Average myelinated axon counts for both nerves were greater at the orbital rim (supraorbital: 6018, supratrochlear: 2533) than at 6 cm distally (supraorbital: 1621, supratrochlear: 1112). Conclusions Anatomic dissection shows relative close approximation of the supraorbital and supratrochlear nerves, with a high proportion of both nerves exiting the orbit through foramina. The supraorbital nerve at the orbital rim contains the greatest number of myelinated axons.

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Restoration of Corneal Sensation With Regional Nerve Transfers and Nerve Grafts

Cited by 117 publications

References 24 publications

PEDF plus DHA modulate inflammation and stimulate nerve regeneration after HSV-1 infection

PEDF plus DHA modulate inflammation and stimulate nerve regeneration after HSV-1 infection

Update on corneal neurotisation

Anatomic characteristics of supraorbital and supratrochlear nerves relevant to their use in corneal neurotization

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